Insights into the Implementation and Operation of a Novel Paramedic Long-term Care Program

Jensen, Jan; Travers, Andrew H.; Marshall, Emily Gard; Leadlay, Stephen; Carter, Alix

doi:10.3109/10903127.2013.831506

Cited by 30 publications

(50 citation statements)

References 18 publications

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“…These shifts occurred in terms of practice location (e.g., paramedics working in emergency department or clinics) [30] but also models of care [1, 11, 31]. For instance, paramedicine was no longer viewed as exclusively emergency response based, offering more in terms of contributions to health and health care:…”

Section: Resultsmentioning

confidence: 99%

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

Tavares

Bowles²,

Donelon³

2016

BMC Health Serv Res

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BackgroundParamedicine is a rapidly evolving health profession with increasing responsibilities and contributions to healthcare. This rapid growth has left the profession with unclear professional and clinical boundaries. Existing defining frameworks may no longer align with the practice of paramedicine or expectations of the public. The purpose of this study was to explore the roles paramedics in Canada are to embody and that align with or support the rapid and ongoing evolution of the profession.MethodsWe used a concurrent mixed methods study design involving a focused discourse analysis (i.e., analysis of language used to describe paramedics and paramedicine) of peer reviewed and grey literature (Phase 1) and in-depth one-on-one semi-structured interviews with key informants in Canadian paramedicine (Phase 2). Data from both methods were analyzed simultaneously throughout and after being merged using inductive thematic analysis.ResultsSaturation was reached after 99 national and international grey and peer reviewed publications and 20 in depth interviews with stakeholders representing six provinces, seven different service/agency types, 11 operational roles and seven provider roles. After merging both data sets three framing concepts, six roles and four crosscutting themes emerged that may be significant to both present-day practice and aspirational. Framing concepts, which provide context, include variable contexts or practice, embedded relationships and a health and social continuum. Roles include clinician, health and social advocate, team member, educator, professional and reflective practitioner. Crosscutting themes including patient safety, adaptability, compassion and communication appear to exist in all roles.ConclusionsThe paramedic profession is experiencing a shift that appears to deviate or at least place a tension on traditional views or models of practice. Underlying and evolving notions of practice are resulting in intended or actual clinical and professional boundaries that may require the profession to re-think how it is defined and/or shaped. Until these framing concepts, roles and crosscutting themes are fully understood, tested and operationalized, tensions between guiding frameworks and actual or intended practice may persist.

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Section: Resultsmentioning

confidence: 99%

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

Tavares

Bowles²,

Donelon³

2016

BMC Health Serv Res

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“…35 Some studies have explored the complexity of transport decisions and the many factors that must be considered by EMS responders. 36,37 Many of the 33 studies included in this review include strategies within the programs reported to provide patients with access to other services, expanded care on scene, or other means of transport to the ED. The body of knowledge related to "mobile integrated healthcare" or "community paramedicine" has become multi-faceted and complex, with many services tailored specifically for the population or community they are aiming to better serve.…”

Section: Alternatives To Transportmentioning

confidence: 99%

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

Jensen

Carter

Rose

et al. 2015

CJEM

Self Cite

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Objectives: Emergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs. Data Source: Broad systematized bibliographic and grey literature searches were conducted. Study Selection: Inclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure. Data Extraction: The reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described. Data Synthesis: The bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n = 44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n = 4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported. Conclusions: Numerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs. RÉSUMÉObjectif: Les programmes de services médicaux d'urgence (SMU), qui offrent une solution de rechange à la répartition traditionnelle des SMU ou au transport classique des malades aux services des urgences (SU), gagnent de plus en plus de terrain. Dans l'examen d'établissement de la portée décrit ici, les auteurs ont relevé et classé tous les résultats utilisés pour mesurer l'efficacité de ces programmes novateurs de SMU. Sources des données: Les auteurs ont entrepris une vaste recherche systématisée de références bibliographiques, et effectué des recherches méthodiques dans la documentation parallèle. Sélection des études: Les critères de sélection comprenaient les appels faits aux services d'urgence 911 ou les malades examinés par les SMU, inscrits dans les rapports de solutions de rechange à la répartition traditionnelle des SMU OU au transport classique des malades au SU par les SMU, ainsi que l'existence d'un critère d'évaluation. Extraction des données: Les rapports ont été classés soit dans la catégorie des solutions de rechange à la répartition des services, soit dans la catégorie des solutions de rechange aux transports effectués par les SMU; quant aux critères d'évaluation, ils ont été classés et décrits. Synthèse...

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“…176 Two studies on decision-making by ambulance staff for patients with epilepsy 174 and elderly fallers 175 both identified a need for additional training and support to aid safe decision-making, as did one Canadian study that focused on out-of-hospital management of patients with long-term conditions. 182 …”

Section: Safety and Decision-makingmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Insights into the Implementation and Operation of a Novel Paramedic Long-term Care Program

Abstract: The ECP program has positive implications for the relationship between EMS and LTC, requires additional paramedic training, and can positively affect LTC patient experiences during acute medical events. ECPs have a novel role to play in end-of-life care and find this new role rewarding.

Cited by 30 publications

References 18 publications

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

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